Evaluation of the Child Health Check Initiative and the Expanding Health Service Delivery Initiative - Final Report

5.2 Progress and status of the EHSDI

Evaluation of the Child Health Check Initiative and the Expanding Health Service Delivery Initiative - Final Report

Page last updated: 17 April 2012

5.2.1 Service expansion
5.2.2 Regionalisation
5.2.3 The RAHC
5.2.4 Infrastructure
5.2.5 Hub services
5.2.6 NT Aboriginal Health Key Performance Indicators
5.2.7 EHSDI expenditure

5.2.1 Service expansion

The Australian Government allocated a total of $17.807 million in 2008–09 and a further $29.910 million in 2009–10 directly to health services to expand core PHC services by employing more staff. A total of 251 
full-time equivalent (FTE) positions were funded within the remote PHC workforce. Further analysis of this funding is included in Section 5.3.


5.2.2 Regionalisation

A regional approach to PHC is intended to create a more efficient and sustainable service delivery model based on economies of scale (DHF website, accessed on 11 June 2010). Initially the NT AHF proposed 14 Health Service Delivery Areas (HSDAs) including the existing two regional health services in Katherine West and Katherine East (Sunrise Health Service). Of the remaining 12 proposed HSDAs, four have been prioritised—West Arnhem, East Arnhem, Barkly and Central Australia. As at February 2011 West Arnhem was the most advanced region in planning for transition to a regional Aboriginal community controlled health service. More information on the regionalisation process is contained in Section 5.5.
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5.2.3 The RAHC

The RAHC was established to address workforce shortages in remote Indigenous communities in the NT by recruiting urban-based health professionals for short-term placements. Aspen Medical Services was selected through a tender process to establish and manage the RAHC program. The first RAHC deployment to the 
NT occurred on 4 December 2008 with two nurses being deployed to Ampilatwatja.

By 31 May 2010, 227 health professionals had been placed on 439 short-term assignments in remote Aboriginal communities across the NT26, including general practitioners, registered nurses, dental health practitioners (included in the RAHC contract from July 2009) and allied health professionals. At the time of 
the evaluation, the RAHC was funded to continue until 30 June 2010. Funding has since been extended to 
30 June 2011. The RAHC is considered in detail in Section 5.6.


5.2.4 Infrastructure

In 2008–09, $13.141 million was spent on infrastructure development to support and strengthen service delivery. This included upgraded information technology and information management systems, refurbishment of clinics and new and refurbished staff accommodation.

The 2009–10 year saw a marked drop in the EHSDI capital and infrastructure funding with $1.714 million spent. Following an EHSDI Regional Infrastructure Assessment project infrastructure funding was sourced from other programs in 2009–10 to support the roll out of the EHSDI. Further analysis of this funding is included in Section 5.3.
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5.2.5 Hub services

As part of the health systems reform in the NT, consideration is being given to what services need to be delivered at different geographical levels, including at the community level, regional or hub level, and territory or jurisdictional level. In comparison to community-level services, regional or hub level services are expected to require more specialised or complex services that require patient’s access on an episodic basis. Hub services have been defined as:
  • those services that are best provided across more than one service or HSDA boundary within 
a region
  • those HSDA services that due to workforce shortages or lack of accommodation or other similar reasons, require the development of an alternate (hub-based) service delivery model to ensure continuing access to services
  • those services that are of a specialty type in which the provider requires access to ongoing professional support to maintain competency (NT AHF, Core Services Framework).
The evaluation team observed a lack of progress on hubs through to the end of 2010. There has been some development including chronic disease hub services based in Darwin and Alice Springs, and DHF audiology services focused on completion of child health check follow-up services. A consultancy has been undertaken focusing on options for models that could further inform the development of hub services (Kristine Battye Consulting 2009), but to date little action has occurred as a result of this review. Two regional hub committees have been set up in Central Australia and the Top End, aiming to coordinate existing hub services across the various agencies that provide them. These committees have not been allocated resources to facilitate this task and again little action has occurred.

Progress has been hindered by the lack of consensus between the NT AHF partners on the role of hub services and a reluctance to expand until this can be addressed. The concept of hubs lacks a definition that clearly anchors it into the existing or future organisational arrangements. Responsibility for hub services is not clear, nor is the relationship between hubs and existing services. The benefits of the theory of concentration of services are well-documented, but to date the discussion has not grasped the imagination of the parties or the services in the NT. A potential way of re-conceptualising the hub concept is discussed in Section 5.4.2.


5.2.6 NT Aboriginal Health Key Performance Indicators

The NT AHKPIs were developed in response to an identified need for a common set of performance indicators for primary health services in the NT. They were to be used across both DHF and ACCHO services. The NT AHKPIs consist of 43 indicators of which 19 indicators (12 quantitative and seven qualitative) have been endorsed by the NT AHF for initial development and collection.

The purpose of the NT AHKPIs is to provide data that will:
  • inform understanding of trends in individuals and population health outcomes
  • identify factors influencing these trends
  • inform appropriate action, planning and policy development
  • act as a tool for CQI.
The development of a territory or state-wide system of KPIs is rare in the Australian health system. The shared NT AHKPIs are indicative of the high level of cooperation and trust between the parties, and the willingness to share information on a common platform. This shows the leadership and innovation that the NT remote PHC sector is demonstrating. The NT AHKPIs, as part of a broader commitment to CQI, are discussed in detail in Section 5.7.
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5.2.7 EHSDI expenditure

As shown in Table 38, total EHSDI expenditure from 1 July 2008–30 June 2010 was $88.572 million. The total allocation for this period was $89.652 million–a difference of $1.081 million. Further detail on EHSDI expenditure is discussed in Section 5.3.

Table 38: EHSDI funding allocation and expenditure to 30 June 2010 ($ million)
2008–092009–10Total
AllocationExpenditureAllocationExpenditureAllocationExpenditure
Service expansion
-
17.807
-
29.910
-
47.717
Regional reform
-
1.201
-
3.976
-
5.177
Hubs
-
0.973
-
1.825
-
2.798
Jurisdictional hearing service
-
-
-
1.800
-
1.800
CQI
-
0.212
-
2.789
-
3.001
Total PHC expansion and transition
-
20.193
41.225
40.300
-
60.493
Capital and infrastructure
-
13.141
0.705
1.714
-
14.855
Workforce (incl. the RAHC)
-
5.001
7.500
6.255
-
11.256
Other (incl. evaluation)
-
0.562
1.270
1.405
-
1.967
Total EHSDI(a)
38.952
38.897
50.700
49.674
89.652
88.572

(a) May not sum to total due to rounding.
Source: DoHA (4 August 2010), NT related health measures—allocation and expenditure 2007–08 to 2011–12; Data supplied by the NT office of OATSIH
26 - From 4 December 2008 to November 2010 RAHC had placed 315 health practitioners in 679 deployments.


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